Reduced beta-cell reserve and pancreatic volume in survivors of childhood acute lymphoblastic leukaemia treated with bone marrow transplantation and total body irradiation.

Autor: Wei, Christina, Thyagiarajan, Manigandan, Hunt, Linda, Cox, Rachel, Bradley, Karin, Elson, Ruth, Hamilton‐Shield, Julian, Stevens, Michael, Crowne, Elizabeth
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Zdroj: Clinical Endocrinology; Jan2015, Vol. 82 Issue 1, p59-67, 9p
Abstrakt: Background Impaired glucose tolerance ( IGT) and diabetes mellitus ( DM) occur more frequently after bone marrow transplantation and total body irradiation ( BMT/ TBI), but the mechanism is unclear. This study investigates insulin sensitivity, β-cell reserve and pancreatic volume in adult survivors of childhood acute lymphoblastic leukaemia ( ALL). Method Survivors (aged 16-26 years) of ALL treated with BMT/ TBI (10-14·4 Gy) Group 1 ( n = 20, 10 m) were compared with a chemotherapy-only Group 2 ( n = 28, 11 m). Participants underwent assessments of insulin sensitivity by whole body composite-insulin-sensitivity-index ( ISIcomp) from oral glucose tolerance tests ( OGTTs); first ( AIRarg, AIRg, AUCin10) and second ( AUC in second phase) phase insulin responses from arginine-intravenous glucose tolerance tests; and pancreatic volume by abdominal magnetic resonance imaging ( MRI). Data were analysed by odds ratio, Chi-square or Fisher's exact tests, Student's t-tests, analysis of covariance ( ancova) and Pearson's or partial correlations (5% significance). Results Abnormal OGTTs were documented in Group 1 ( DM = 2, IGT = 7). Insulin secretion adjusted for insulin sensitivity was lower in Group 1 than Group 2 as a whole [Log AIRarg ( P = 0·008), log AIRg ( P = 0·013) and log AUCin10 ( P = 0·014)] and after exclusion of those with abnormal glucose tolerance [log AIRarg ( P = 0·011), log AIRg ( P = 0·007) and log AUCin10 ( P = 0·006)]. Group 1 had lower pancreatic volume than Group 2 [52·0 (14·2) vs 72·8 (23·5), P = 0·001] cm3, and results were consistent after adjustment for size by body surface area ( P = 0·019). Pancreatic volume correlated with log AIRarg adjusted log ISIcomp (partial correlation = 0·34, P = 0·025). Conclusions Adult survivors of childhood BMT/ TBI for ALL demonstrated reduced β-cell reserve and smaller pancreatic volume, both likely additional aetiological factors, with reduced insulin sensitivity, in their increased risk of diabetes. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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